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Saturday, August 14, 2010

Flexibility Training After Low-Back Surgery

I received and email from blog reader, Jeremy, who had a (L4-L5) lumbar spinal fusion surgery in May this year. For those of you who are not familiar with the surgery, two (or more) vertebrae are surgically connected together so they no longer have mobility. Usually the jelly-like intervertebral disc is removed and replaced with a rigid plastic or metal spacer. This surgery is performed for a variety of reasons, including: scoliosis, degenerative disc disease, herniated disc, and more.

Jeremy has completed physical therapy and is now cleared by his physician to resume light exercise. His question is, what exercise is appropriate for him now? He does have a lot of muscle tightness in his lower back (as expected).

First, an important fact to remember is that the spine does not tolerate bending, twisting or compression well and these movements should be avoided as much as possible. Second, just about all of our spines are somewhat out of alignment and often in a flexed posture (bent forward) due to sitting and gravity. Third, the spine is stiffest early in the morning due to the discs fully hydrating while lying down. As the day goes on, the discs lose hydration and the vertebrae move more easily. That is why most back pain occurs early in the morning or after sitting for a while.

Early exercise should focus on restoring spine alignment and improving hip and shoulder flexibility/mobility. Even though the lower back muscles feel tight, you should not bend, twist, or contort the spine to attempt to stretch out the tight lower back muscles. A neutral (natural, not flexed, twisted, or hyper-extended) spine should be maintained with all exercises as you gradually work on the hip and shoulder muscles. Additionally, self-myofascial release (foam rolling) can be used to loosen the low back muscles, hips and legs.

Below, in the video, is a series of exercises that can be done to loosen up the back (and hip and shoulder muscles that have myofascial connections to the spine) improve flexibility, and prepare for more challenging exercises. After these exercises improve spinal alignment and flexibility, then 'core' stability with a variety of movement patterns (lunging, squatting, lifting,carrying, etc.) can be trained. Always maintaining a neutral spine. This series of exercises can be done a couple times per day (0:15 each session), even early in the morning when the spine and all the muscle are stiffest.

7 comments:

Strongly agree with all this, and the other posts I've seen except for the bacon one- I'm a vegan.

A couple things I'd add for early lumbar work are standing on one leg and doing circles with the opposite knee(and therefore hip.) Prior to foam rolling on the floor, putting a couple tennis balls in a sock and rolling them between the lower paraspinals and the wall.

You do show windmills in an earlier post. How do you avoid low back twisting and shearing with them?

Thanks for your input, Steven. I guess the bacon is a mute point if you are a vegan! The tennis ball rolling in a sock is a good idea, too.

The windmills are definitely not an early low back training exercise. However, the post with the windmills was about using them for an assessment and to maintain and develop quality movement patterns. The windmill can be done with minimal shearing stress on the spine with excellent hip and shoulder mobility. But, most people don't have that. So, if I had a new client come in and tell me they had a low back surgery within the last six months, I would start by looking at passive ROM. Then, we would progress to basic movements (such a bodyweight squat), looking at how they are moving (or if they have pain). If a client flies through all of these movements with ease, then we can get into some more complex movements (like a Turkish Get-Up or Windmills).

Also, this video focuses on enhancing hip and shoulder mobility. Once a client develops adequate mobility, then we will work on torso stability (in a neutral spine position) and grooving proper movement patterns. Ultimately, we want to progress torso stability and build more shoulder and hip strength and endurance.

Over the last 100 years, chiropractic medicine has been leading the field as the most natural and non-invasive approaches to treating chronic spinal pain conditions. Chiropractic care focuses on relieving the tension or inflammation to the delicate nerves of the spine. This irritation to spinal nerves is the chief cause of spinal pain. When chiropractic adjustments are given to relieve the pressure placed on the nerves of the spine, relief is noticed almost instantly. This relationship between the spine and nervous system is the main focus of chiropractic treatment. With Chiropractic care, patients not only respond fast to spine pain conditions, but also to conditions of the entire body as well. chiropractors duluth ga

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